Team dynamics, clinical work satisfaction, and patient care coordination between primary care providers: A mixed methods study.

Background: Team-based care is essential for delivering high-quality, comprehensive, and coordinated care. Despite considerable research about the effects of team-based care on patient outcomes, few studies have examined how team dynamics relate to provider outcomes.

Purpose: The aim of this study was to examine relationships among team dynamics, primary care provider (PCP) clinical work satisfaction, and patient care coordination between PCPs in 18 Harvard-affiliated primary care practices participating in Harvard's Academic Innovations Collaborative.

Behavioral health integration in primary care at Brigham and Women׳s Advanced Primary Care Associates, South Huntington.

Of the many problems facing the US healthcare system, the shortage of behavioral health providers in outpatient settings is particularly profound. To address this issue, Boston׳s Brigham and Women׳s Hospital identified ways to incorporate behavioral health into primary care when it opened the South Huntington Primary Care clinic in August 2011. When the needs of its patients were more complex than anticipated, the clinic created assessment tools and refined care processes to identify, triage, and monitor patients with mental illness.

Recognition by Women's Health Care Providers of Long-Term Cardiovascular Disease Risk After Preeclampsia.

Objective: To assess health care providers' knowledge regarding pregnancy outcome as a risk factor for cardiovascular disease and evaluate the variables associated with their responses to questions about routine surveillance for cardiovascular disease.

Methods: A voluntary, anonymous survey of internal medicine and obstetric and gynecologic health care providers at an academic institution. Responses to a case-based and direct inquiry questionnaire were evaluated.

Design of a cluster-randomized trial of electronic health record-based tools to address overweight and obesity in primary care.

Background: Primary care providers often fail to identify patients who are overweight or obese or discuss weight management with them. Electronic health record-based tools may help providers with the assessment and management of overweight and obesity.

Purpose: We describe the design of a trial to examine the effectiveness of electronic health record-based tools for the assessment and management of overweight and obesity among adult primary care patients, as well as the challenges we encountered.

The "medical neighborhood": integrating primary and specialty care for ambulatory patients.

As health care organizations create larger networks, better coordination of primary and specialty care is paramount. Attention has focused on strengthening primary care by creating patient-centered medical homes. The "medical neighborhood" provides a framework for structured, reciprocal relationships that integrate specialty care and extend the principles of the medical home to all practicing physicians.

Disparities among the disadvantaged: variation in lipid management in the Ohio Medicaid program.

Background: Racial disparities exist in cardiovascular disease (CVD) prevention, but other non-clinical factors may influence treatment, further exacerbating disparities.

Methods: Using Ohio Medicaid data from 1992 to 1999, we identified a sample of 19,106 individuals with CVD-related diagnoses or procedures. A review of pharmacy claims identified previous, new, and long-term users of lipid-lowering agents, including statins, fibrates, and bile sequestrants.

Physicians' attitudes and preventive care delivery: insights from the DOPC study.

Background: Interventions that modify physician attitudes to enhance preventive service delivery are common, yet other factors may be relatively more important in determining whether these services are provided. We assessed associations between physicians' attitudes and delivery of preventive care, compared with factors related to the patient, visit, or practice.

Methods: One hundred twenty-eight primary care physicians rated the importance of five preventive services and their effectiveness at delivering them.

Impact of nonprescriptive factors on low-density lipoprotein cholesterol reduction with statins.

Nonprescriptive factors, including patient adherence, can affect the fluctuations in low-density lipoprotein (LDL) cholesterol observed in the clinical setting. In 241 statin-treated patients, although drugs and doses remained fixed, 57% of patients initially successful in reaching LDL cholesterol targets showed subsequent increases in LDL cholesterol. Conversely, 60% of patients who initially failed to reach targets had subsequent reductions in LDL cholesterol, with nearly 1/3 eventually attaining their LDL cholesterol goals.

Physician - nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients' perception of care.

Increasing demand to deliver and document therapeutic and preventive care sharpens the need for disease management strategies that accomplish these goals efficiently while preserving quality of care. The purpose of this study was to compare selected outcomes for a new chronic disease management program involving a nurse practitioner - physician team with those of an existing model of care. One hundred fifty-seven patients with hypertension and diabetes mellitus were randomly assigned to their primary care physician and a nurse practitioner or their primary care physician alone.

Frequent ventricular ectopy after exercise as a predictor of death.

Background: Exercise-induced ventricular ectopy predicts an increased risk of death in population-based cohorts. We sought to examine in a clinical cohort the prognostic importance of ventricular ectopy immediately after exercise, when reactivation of parasympathetic activity occurs. We hypothesized that ventricular ectopy after exercise (i.

Statins do not meet expectations for lowering low-density lipoprotein cholesterol levels when used in clinical practice.

Background: Statins have become a mainstay in the treatment of hyperlipidemia, based on their potency and favorable side-effect profile. Drug choice is presumed to be guided by the estimated degree of low-density lipoprotein (LDL) cholesterol lowering required in a particular patient and the projected efficacy of any drug-dose combination, as contained in the package inserts for each medication. We investigated whether these expectations were met in a clinical practice.